CSRO, Underwater Biosimilars Coalition Submit Testimony on FY27 LHHS Appropriations | | |
Yesterday, Dr. Madelaine Feldman, on behalf of CSRO and the Underwater Biosimilars Coalition, urged Congress to include report language to accompany the FY 2027 Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill directing CMS to address ongoing reimbursement challenges for provider-administered biosimilars. The Coalition highlights that, in some cases, Medicare payment rates fall below acquisition costs, which create access barriers and undermine the financial viability of furnishing these therapies in physician offices and infusion centers. In addition, recognizing that fully resolving these reimbursement challenges may require more complex and costly policy changes, the groups also called for a targeted, near-term solution to establish a Medicare Advantage formulary adequacy standard. Modeled on existing network adequacy requirements, this policy would ensure that any biosimilar placed in a step therapy protocol is actually available to network providers, addressing what CSRO refers to as “ghost formularies,” where products appear covered but are not meaningfully accessible. If the preferred biosimilar is not reasonably available, plans would be required to allow timely access to an alternative product without additional utilization management. CMS would also be directed to report to Congress on the drivers and impact of these challenges.
Read more in the testimony.
| | New Proposals Would Address Interoperability, Prior Authorization for Medications | | On April 10, 2026, the Centers for Medicare and Medicaid Services (CMS), in conjunction with the Office of the National Coordinator for Health IT (ONC), released a proposed rule that aims to “advance sweeping reforms to modernize prior authorization for drugs by establishing clear decision deadlines for impacted payers – no later than 24 hours for urgent requests and 72 hours for standard requests – and increasing transparency through full disclosure of claims denials and appeals outcomes.” A press release on the rule explains that the proposals build on CMS’ 2024 Interoperability and Prior Authorization final rule, which addressed prior authorization for non-drug items and services. The press release also highlights CMS’ solicitation of public input on five Requests for Information (RFIs), including one focused on “streamlining step therapy processes.” CSRO will provide feedback on the proposals, including the aforementioned RFI, independently and in collaboration with the joint ACR-CSRO Underwater Biosimilars Coalition. Additional details about the proposals can be found in an accompanying fact sheet. | | Legislation Around the Country | | VA: CSRO’s Advocacy Pays Off - Governor Amends Harmful PDAB Bill | | |
In the final hours before the Governor’s Action Deadline, Governor Spanberger (D-VA) sent amendments back to the legislature on the Virginia Prescription Drug Affordability Board (PDAB) legislation (SB 271). The Governor’s amendments include a reenactment clause that would require the state legislature to vote again on the section that establishes a PDAB. This section also includes language that would establish an Upper Payment Limit based on the CMS Maximum Fair Price (MFP) of a drug as determined through the Medicare Drug Price Negotiation Program and cap physician reimbursement at that limit. The legislature would not be able to vote again on the PDAB language until it reconvenes during the 2027 session, or if a special session is called.
In Virginia, the Governor has the ability not only to line-item veto provisions within a bill but also to offer new amendments to legislation. Those amendments are received by the legislature and reviewed by the General Assembly during a special veto session. The veto session is expected to begin later this month, during which the legislature can accept or override the Governor’s amendments. The House of Delegates and the Senate can then accept or reject her amended bill and then send it back to her for final signature. If the Governor disagrees with legislation sent back by the legislature, she can veto it; then, a two-thirds vote in both chambers is required to override the Governor’s veto.
In several letters to the state legislature and Governor Spanberger, CSRO expressed serious concerns over the impact the PDAB could have on physician reimbursement for buy-and-bill, as well as patient access to essential provider-administered medications. If the Governor had not amended the bill, Virginia would have been the first state to create a PDAB that ties state price caps to Medicare’s MFP. CSRO Board member Harry Gewanter, MD continued to drive engagement on the ground working to educate legislators and the Governor’s office about this bill. Dr. Gewanter also spearheaded a letter signed by 58 Virginia-based physicians to urge the Governor to veto the legislation.
Thank you to those who joined CSRO in taking action on this issue!
CSRO applauds Governor Spanberger’s amendments to the PDAB bill and urges the state legislature to accept this updated proposal and only advance proven solutions to drug affordability.
| NH: CSRO Urges Legislature to Pass Legislation Banning White Bagging Mandates | |
CSRO is taking action in New Hampshire to protect patients and rheumatology practices from harmful white bagging mandates. Last week, CSRO submitted formal comments to the House Committee on Commerce and Consumer Affairs in support of SB 256, legislation that would ban health plans and PBMs from requiring patients and providers to use specific specialty pharmacies — typically those owned by the PBM itself.
In its comments, CSRO outlined the serious risks white bagging mandates pose to the buy-and-bill model that rheumatology practices rely on to deliver safe and effective care to their patients. White bagging mandates pose serious patient risks and liabilities — from shipping delays and improper medication handling to higher patient cost-sharing obligations that put medically necessary treatments out of reach for many patients with chronic conditions. CSRO stressed to lawmakers that passing SB 256 is critical to addressing the safety and liability concerns created by white bagging mandates, while preserving patient choice and protecting the buy-and-bill model that drives higher drug adherence for rheumatology patients.
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Want to learn more about the legislation introduced in your state? Visit CSRO’s Map Tool to find all of the new and enacted bills within CSRO’s policy priorities.
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What's Happening in the States
Interested in learning more about CSRO’s engagement in the states? Visit our State Legislation Correspondence page to review the letters submitted to state legislatures on CSRO’s priority issues.
| Click above to access CSRO’s new State Legislative Tracker to find the status of CSRO’s priority legislation affecting the rheumatology community and its patients at the state level. | | Mark Your Calendar: Upcoming Events
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Business of Rheumatology Seminar Series - Decoding the “Big Beautiful Bill”: Practical Strategies for Rheumatology Practices: July 1, 2026
Join us for a timely and informative webinar exploring evolving payer strategies—including potential Medicare and Medicaid cuts—and what they could mean for practice sustainability, reimbursement, and patient access. This session is part of our ongoing webinar series, generously supported by Johnson & Johnson.
Register here!
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Business of Rheumatology Seminar Series - Building a Clinical Research Program in Community Rheumatology Practice: September 16, 2026
Join us for the September Business of Rheumatology webinar as we discuss how practices can successfully engage in clinical research to improve patient care and support practice growth. This session is part of our ongoing webinar series, with support from Johnson & Johnson.
Register here!
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Day on the Hill: October 2, 2026
Mark your calendars to join us in Washington D.C. for CSRO's Day on the Hill!
Registration will launch on Wednesday, April 22.
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Advocacy Conference: October 2-3, 2026
Join us in Washington, D.C. for CSRO’s flagship Advocacy Conference to learn, network, and strategize around patient access to care.
Sign up for the Registration Launch here!
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Business of Rheumatology Seminar Series - Smart Payer Contracting and Transparency in Coverage: December 2, 2026
Join us for our December Business of Rheumatology webinar to learn how to navigate payer contract negotiations with confidence. This session is part of our ongoing webinar series, generously supported by Johnson & Johnson.
Register here!
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Explanatory Statement: “Underwater” Biosimilars
To aid in addressing the issue of "underwater" biosimilars with payers, CSRO has created a document to illustrate the extent of the problem.
Legislative Map Tool
Find your state on our interactive map tool to learn about current or proposed policy and ways you can take action to make an impact.
Payer Issues Reporting Form
Request assistance with any payer relation issues that may be impacting your patients or office.
Policy Correspondence
Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.
Rheum for Action
Learn about the latest advocacy issues in CSRO's advocacy column authored by Dr. Madelaine Feldman and produced in partnership with Medscape.
Step Therapy Cover Sheets
Review CSRO's state-specific step therapy materials that help guide practices in gaining an exemption from step therapy protocols.
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Questions?
Please visit the CSRO website for other news and updates, and do not hesitate to contact us with any questions at info@csro.info.
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